Tummy Tuck Variations

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Tummy Tuck variations may mean different things to different people. The right choice for the abdomen is highly individualized. So, we checked in with some of the nation’s leading plastic surgeons to learn about the latest in Tummy Tuck Variations.

When Is A Tummy Tuck The Right Choice?

“There are a variety of reasons that may make a Tummy Tuck the right choice. From the start, it is important to identify what is the healthy goal weight of the patient. Ideally, I recommend that the time to get serious about a Tummy Tuck is when you are within 25% of your goal weight. Imagine how much your tummy can deflate by losing 5 lbs., the equivalent of a 5 lb. sugar bag. Then, think about 10 lbs. Losing weight can make a big difference for many women. We extend consultations to women with big round tummies; big pouch tummies that hang over the belt; pear shaped tummies; and banana shaped tummies after the birth of twins.  To see if a Tummy Tuck is right for you, there are a lot of good online resources that can show before and after photos and may provide a lot of good information. There is also a lot of misinformation. What we do in consultation is supplement this research with professional information, amplify what is accurate, correct what is wrong and develop an appropriate treatment plan. Plastic surgery is an investment in safety, time, recovery and money.   We want to ensure our patients can make well educated decisions that are in their best interest. In the end, an alternative may be the better choice, but the way to identify the right plan for you is to consult with a board certified plastic surgeon.” explained Dr. Navin Singh of Washington, D.C.

“Abdominal contouring can be accomplished as a non-invasive, minimally invasive, or open surgical procedure. The decision which to have (or which combination to have) will depend on factors such as recovery time, cost, and, of course, the goals of the patient. A Tummy Tuck may be appropriate for a woman who has lost excessive weight and has excess skin, those with medical conditions, such as a rash due to a protrusion of the abdomen; and those with a lower abdominal pouch, such as a Mom.  In short, a Tummy Tuck is performed to plicate the muscles, tightening them to restore a flattened tummy. I always perform liposuction (fat removal) with the Tummy Tuck and sometimes, I trim looseness or excess skin from front, center and back. There are cases whereby liposuction alone may be the right choice, if excess fat or contouring is the only issue.  A non-invasive option for very small fat deposits is Cool Sculpting. This involves freezing the fat to have it naturally dissolve in the body.”    explained Michael Baumholtz, MD, FACS, San Antonio, Texas.

“There have been common misconceptions about the decision for tummy tuck or liposuction.  In some cases, people believe that liposuction is the right answer, but they may be better candidates for tummy tuck. Conversely,   liposuction may be the right choice or an adjunct to the procedure.  Often times, the final result from a tummy tuck may be optimized with liposuction in the surrounding areas, such as the hips, back, and other areas of the body. There are also other newer choices.  If you are interested in removing excess skin following a pregnancy, a Skin Only Abdominoplasty may be the right solution. Cool Sculpting treats excess skin on the abdomen with a targeted cooling process that destroys the fat cells underneath the skin. Smartlipo and Smartlipo Triplex for fat reduction and up to 20% skin tightening in all areas of the face and body, except the ankles. Cellulaze uses Smartlipo Triplex technology to diminish cellulite on the arms, chest, abdomen, waist, back hips, buttocks, inner thighs, outer thighs, and/or knees.”  explained Dr. Laurie Casas, M.D. F.A.C.S., Chicago, Il.

Is The Tummy Tuck Safe?

“Cosmetic plastic surgery in general and specifically the Tummy Tuck is very safe, but the procedures need to be performed in a licensed and properly credentialed facility, by a qualified plastic surgeon. It is wise to seek out cosmetic plastic surgeons certified by the American Board of Plastic Surgery which is the only board recognized by the AMA’s American Board of Medical Specialties for the practice of cosmetic surgery on the head, neck and entire body.   Ask whether or not your surgeon is a member of the American Society of Plastic Surgeons (ASPS) and/or The American Society for Aesthetic Plastic Surgery (ASAPS). Membership in those society ensures that the surgeon is  certified by the American Board of Plastic Surgery, and operates in a licensed and credentialed facility – all essential for your safety! The American Society for Aesthetic Plastic Surgery is the largest organization in the world dedicated to cosmetic surgery and requires that their plastic surgeon members demonstrate additional expertise in cosmetic surgery of the face, neck and entire body; present caseloads for peer review; and perform their procedures in a licensed facility. A facility that has been state licensed and properly credentialed ensures that the facility is up-to-date operationally with proper safety equipment and protocols in place, as well as, appropriately trained and licensed personnel; all necessary not only for a good surgical outcome but more importantly patient safety. Also, don’t be afraid to obtain a second opinion. You need to be comfortable with the whole package, including: the surgeon, the office, the surgeon’s staff and the operative facility.” explained Leo McCafferty, M.D., F.A.C.S., Pittsburgh, PA.

What Types of Variations Do You Employ in Your Tummy Tucks?

“It’s important for women to understand that the ” tummy” (abdomen) is comprised of 4 components that contribute to appearance. The skin layer is the most superficial  followed by subcutaneous fat then the muscle (abdominal) wall, and finally the visceral fat surrounding the abdominal organs. Plastic surgery can address the first three components but the visceral fat must be addressed with proper nutrition and exercise. If the problem is simply too much fat between the skin and the abdominal wall,  then Liposuction and or one of the non-invasive body contouring modalities such as CoolSculpting may be indicated. If there is laxity in the skin above and below the umbilicus with or without excessive fat and the abdominal wall (core muscles) need to be tightened,  a full abdominoplasty is required. Most patients understand that a full abdominoplasty will remove excess skin and fat, but some are surprised to learn that their core muscles will be tightened. This latter aspect improves posture, sometimes can alleviate back discomfort, and always improves the ability to exercise. Rarely, if there is minimal skin and/or fat redundancy and the problem is just stretching or laxity of the core muscles from pregnancy or weight fluctuation, the procedure may be performed with  an endoscope which requires a slightly smaller incision. A “mini Tummy Tuck” may be performed to treat the area from the navel down. For example, it is  very common in women with a C-section or hysterectomy scar to have  excess lower abdominal  skin and fat which can be easily taken care of with this “mini” procedure.  Liposuction may be performed together with the Tummy Tuck, but this requires careful patient selection because performing procedures together may increase risks unnecessarily. Staging the procedures by performing Liposuction either before or after a Tummy Tuck may be best in certain circumstances and should be discussed with your plastic surgeon.  The Tummy Tuck, just like all plastic surgery operations, is not a cookie cutter procedure. The approach and procedure should be highly individualized to provide the best outcome with highest degree of safety.” explained Leo McCafferty, M.D., F.A.C.S., Pittsburgh, PA.

“The Tummy Tuck combines both a scientific and artistic approach that is highly individualized. I perform the popularized Avelar approach asleep or AWAKE, depending upon preference. The best part is that the women do not experience pain during the procedure when awake and the recovery involves the administration of Percocet for the first 48 hours; then one a day for up to three days. Women who have the Avelar Tummy Tuck may be housebound for two days, but when compared to a Full Tummy Tuck involving approximately 10 days before return to work, the Avelar is advantageous for the right candidate. The drainless approach using progressive tension sutures is also a good technique, but has limitations in terms of the amount of loose skin that can be corrected (½ to 1 inch of extra skin when compared to an amazing result for those in this category who have the traditional Tummy Tuck instead).  In addition, the goal may be to forgo a drain and most of the time drains can be avoided, but the downside of a drain is really not a big deal since women are hiding in recovery during this time period and the lidocaine in the drain is very comforting.  A variation of the drainless approach is known as the Stratafix? which I do perform on occasion. Another approach that is popular in my practice is Tummy Tuck with Abdominal Etching. Many women I see have more loose skin than anything and they do have results from their work outs hidden under their skin. So, I can etch out some of their natural contours and they can show off the results of their work outs, resulting in six pack abs. In fact, we have many women in their 30’s who get the Tummy Tuck and then their Moms, in their 60’s and 70’s, get one after they see their daughters’ results. The take away here is that we design the appropriate treatment plan for every patient based on our extensive diverse experience in a wide variety of techniques that we have used for many years. We also keep up-to-date with the latest to enhance patient care.” explained Navin Singh of Washington, D.C.

“I am of the opinion that there are many great plastic surgeons and each plastic surgeon picks up their own tips and pearls to refine their techniques and pull out specific tricks when applicable to the patients’ needs. Having vast experience with a litany of techniques to choose from, I select the techniques that work best for each patient.   A good diagnosis is fundamental to making the right choices. This focuses on addressing what the patient’s concerns are, which may not necessarily be what the plastic surgeon views as potential improvements. When comparing different results in before and after patient photos, one hallmark of a good Tummy Tuck is a nice belly button; not one with a big scar wrapped around it. Of course, we cannot control wound healing, but great plastic surgeons can put the patient in the best position to have a good result.” explained Adam J Rubinstein, MD, FACS, Miami, Florida

What’s the Difference Between The Mini Tummy Tuck and the Traditional Tummy Tuck?

“The Mini Tummy Tuck is designed to treat the area from the navel to the pubic line whereas the traditional Tummy Tuck focuses on the area that extends from the rib cage down. Women interested in a Tummy Tuck need to be aware that there are limitations to a Mini Tummy Tuck. It is important to note that the longer the scar, the better the result. In this way, a traditional Tummy Tuck is often the wiser choice for many women.”   explained Adam J Rubinstein, MD, FACS, Miami, Florida

What About Combining Procedures? 

“I frequently combine Liposuction with the Tummy Tuck procedure; not only for the tummy, but for the mid- section as well.  This may include the hips, flanks and outer thighs for overall improved body contours. In Florida, like several other states, only 1 liter of liposuctioned  fat may be removed in an office based facility. This may be a consideration for some women who require removal of more fat for better results; requiring the procedure be performed in a hospital with such state regulations. Large volume Liposuction is considered 4 liters of fat or more. In this case, I perform the Liposuction procedure as a first stage with the Tummy tuck being performed in over three months’ time as a second stage procedure. If a woman is having a health related procedure involving the abdomen, such as tubal ligation or hysterectomy, this usually makes a terrific time to have the Tummy Tuck. First, it turns a negative experience into a positive one.  In addition, by doing both procedures simultaneously, you can save money and benefit from one recovery. It is not uncommon for gynecologists to work in conjunction with plastic surgeons.”   explained Adam J Rubinstein, MD, FACS, Miami, Florida

What’s Exciting In Recovery Discomfort Management?

“There are numerous ways to make recovery quicker and pain free. Tummy Tucks have a taken bad rap for being painful and often this is a patient’s biggest concern. However, the abdominoplasty  procedure today, like most modern cosmetic operations, are less invasive and done with less extensive disturbance to the patient’s anatomy, resulting in much less postoperative pain and quicker recovery. I do not find pain pumps are necessary, but oral pain medication allows for comfort during the first few days following surgery. Recently, I had a patient who just used Tylenol. Patients can usually return to exercise after two weeks. It is wise to avoid combining abdominoplasty with other large cosmetic procedures. This will reduce surgical time, allowing for a speedier,  more comfortable recovery and a very safe experience overall. Patients might be surprised to know that early mobilization is the norm and they will feel comfortable  walking around the house upright (not hunched over) within 24 hours which also promotes  a quicker and smoother recovery. These are just a few of the ways I help ensure a safe and comfortable recovery any type of  Tummy Tuck.”  explained Leo McCafferty, M.D., F.A.C.S., Pittsburgh, PA.

“There have been two major advancements that I have noticed in my practice. First, there is the Exparel injection, an alternative to opioid medications which are associated with side effects, such as drowsiness, nausea, and vomiting.  In addition, Exparel offers greater comfort. I find that women are walking the same day and require half the pain meds during the recovery time period. The mobility benefit alone is advantageous because post-surgical risks are reduced, such as, blood clot and pneumonia risks. Secondly, women prefer my use of quill barb sutures because knotting is required on the skin for the incision and quill barb sutures allow for less knotting, which is less irritating to women who have Tummy Tucks.” explained Michael Baumholtz, MD, FACS, San Antonio, Texas.

“With the advantages of the Avelar Abdominoplasty, I have found that the recovery is similar to liposuction alone.  Women are walking the next day which reduces blood clot risks, the tissue is more natural or less firm, and drains do not typically remain in place for nearly as long, if at all necessary. For the right candidate, it is a wonderful alternative.” explained Dr. Maurice Sherman of Del Mar, California.

“In terms of recovery, pain pumps allow for a slow waterfall flow of lidocaine into the tummy for full time numbing of the tummy which makes the first few days a lot more comfortable.  In fact, the flow rate is so slow pain pumps are not associated with nausea or vomiting and many find they use less narcotics, which also reduces the risk of nausea and vomiting. Exparel is recent breakthrough that offers relief for two to three days so women can rely less on narcotics.”   Adam J Rubinstein, MD, FACS, Miami, Florida